
When ERP Breaks Down -- Best Practices for Troubleshooting
This presentation will be an ONLINE VIRTUAL LIVE broadcast on December 11, 2026, from 1:00 pm - 2:00 pm ET. While this activity is LIVE and can only be viewed during the time specified, the evaluation will be available online until January 7, 2027. Go to the Overview tab to learn how to participate for continuing education credit, watch the broadcast and download the slides.
The views and opinions expressed by this presenter in this lecture are their own, and do not represent the views of Sheppard Pratt.
Exposure and response prevention is the most strongly supported treatment we have for OCD, and yet most clinicians can name a patient for whom it seemed to stop working or never worked for. The usual response is to intensify the protocol or try something else and that instinct is often wrong. In our experience, apparent ERP failure is rarely a failure of the treatment itself. It is far more often a diagnostic problem or an application problem. Oftentimes, the presentation is not OCD or not only OCD; the patient is measuring success by whether their anxiety dropped rather than by what they were willing to do; or the exposures are touching triggers while the core feared outcome, and the mental rituals protecting it, remain untouched. What is missing in most settings is not effort or fidelity to a manual, but a structured way to work out which of these is happening before changing the plan.
Target Audience
This activity is intended for physicians, nurses, psychologists, social workers, counselors, and other mental health professionals.
Learning Objectives
At the conclusion of this activity, attendees will be able to:
- Describe how to re-assess case conceptualization when a patient is not responding to treatment.
- Discuss how a patient's continued focus on symptom relief and emotional comfort, rather than willingness and uncertainty tolerance, undermines ERP outcomes.
- Explain the difference of using ERP for trigger reduction versus fear reduction.
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Price: Free. All courses offered through Sheppard Pratt are free of charge. There is no need to cancel if you cannot attend or complete a course, as no refund is necessary. Not completing an activity acts as a cancellation.
For more information on how to participate in this course, please read to the bottom of the page to review all of the directions.
For directions on how to participate in the program, refer to the FAQ page.
To participate in the interactive synchronous distance learning format course, you will download the handout, watch a webcast of the live broadcast hosted through Notified, and complete the required pretest, posttest, evaluation, and attestation for credit. Once you have completed all the components of the Course Progress bar, the certificate will be available for immediate download. The certificate will also be saved in your account transcript.
Outline of Activity:
1:00- 1:05 pm: Introduction
1:06- 1:50 pm: Presentation
1:51- 2:00 pm: Q&A
2:00 pm: End of event
Registration closes on December 11, 2026, at 12:59 am ET. The course expires and cannot be completed after January 7, 2027.
Please contact [email protected], if you have questions, concerns, grievances, or for ADA accommodations.
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TO EARN CONTINUING EDUCATION CREDIT FOR YOUR ATTENDANCE
1. Before the Event
- Log in to Your Ethos Account:
Access your Sheppard Pratt Ethos account and locate the activity by series, title, or speaker name. - Register for the Course:
Go to the Register tab, click the green Take Course button, and follow the prompts. - Complete the Pretest.
Note: You cannot proceed beyond this point until your attendance is confirmed by entering the codeword. - Access the Broadcast Link:
Close out of the course and go back to the Overview Tab of the course page to access the broadcast link. The live broadcast link is located on the Overview tab of the course page. You do not need the codeword to watch the broadcast.
2. Register to Watch the Live Broadcast (Separate from Course Registration)
Important: This registration is different from registering for the course in Ethos. You must complete both registrations to watch the broadcast and earn credit.
How to Register:
- Click the Broadcast Registration Link (also located in the Overview tab): Link coming soon
- Enter your first name, last name, and email address. Click Submit.
How to Join:
- At the scheduled time, use the same link.
- If you have already registered, scroll down and click Already Registered, then enter your registered email address and click Submit.
- The broadcast link will be active at 12:30 PM.
3. Download the Handout
- The handout will be available for download on Thursday, November 19, 2026, at 12:00 PM ET.
Download Handout:
4. During the Event
- Attendance Verification:
A codeword will be announced during the live broadcast. This codeword confirms your attendance and unlocks the remaining required components for credit. - How to Submit the Codeword:
- Via Website: Go to https://cme.sheppardpratt.org/code and enter the codeword.
- Via SMS: Text the codeword to 410-291-8061.
Tip: Save this number in your contacts for convenience. - Via Course Progress Bar: You can type in the codeword in the box where it asks for it after you complete the Pretest.
Important:
The codeword submission window remains open for nearly four weeks. High traffic may cause delays immediately after the event. If the system is slow, wait and try again later.
5. After the Lecture
- Go to My Account > Pending Courses and select the course by clicking the course title.
- Click Take Course and use the navigation buttons in the lower right corner for best results.
- Complete all components in the Course Progress Bar:
- Posttest
- Evaluation
- Credit designation
- Once completed, the certificate will be available for immediate download. Your transcript will reflect the earned credits.
Questions?
Visit our FAQ page or email [email protected]
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Course summary
- 1.00 ACEP NBCC clock hours
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Category I credits for Social Workers
- 1.00 Psychologists
- 1.00 MNA Contact Hours for Nurses
- 1.00 Participation
There is no commercial support for this activity.
About the speakers
Elizabeth McIngvale, Ph.D., LCSW is the director of the OCD Institute of Texas, Co-Founder of MHNTI and adjunct faculty at Baylor College of Medicine. A nationally and internationally recognized authority on obsessive-compulsive disorder (OCD), Dr. McIngvale has published over 35 peer-reviewed journal articles, multiple textbook chapters and is a sought-after contributor to national expert panels, media, and conferences. Dr. McIngvale founded the Peace of Mind Foundation and OCDChallenge.org, one of the first widely used online self-help tools for OCD, both now housed within the IOCDF. She has delivered over 250 public lectures, talks and keynotes, facilitated dozens of national and international webinars—including the IOCDF’s flagship educational series—and served on several expert panels including NIH and SAMHSA panels. She is also a faculty instructor for the IOCDF’s Behavioral Therapy Training Institute. Known for her bold public advocacy and engaging speaking style, Dr. McIngvale is a trusted voice in OCD treatment, education, and policy. Diagnosed with OCD at age 12, Dr. McIngvale brings a unique dual perspective as both a clinician and someone with lived experience. She was the first-ever national spokesperson for the International OCD Foundation (IOCDF), where she now serves as a board member. She remains deeply committed to advancing clinical research and expanding access to high-quality care for those living with OCD, Anxiety Disorders and related disorders.
Ryan Judd, LCSW-S, is the clinical director and one of the behavior therapists at OCDI Texas. Ryan has experience working with adults, adolescents, and children in a variety of mental health treatment settings. Ryan has several years of experience treating severe OCD, BDD, and anxiety disorders. Ryan is an advocate for the promotion of Cognitive Behavioral Therapy (CBT) and its wide use in the treatment of different mental health conditions.
Ryan received his Bachelor’s and Master’s of Social Work from Tulane University in New Orleans. He is currently licensed to practice in Texas, New York, and California. He is a licensed clinical supervisor in the state of Texas.
Disclosure Statements
Sheppard Pratt holds the standard that its continuing medical education programs should be free of commercial bias and conflict of interest. In accord with Sheppard Pratt's Disclosure Policy, as well as standards of the Accreditation Council for Continuing Medical Education (ACCME) and the American Medical Association (AMA), all planners, reviewers, speakers and persons in control of content have been asked to disclose any relationship he /she has with any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 24 months. All planners, reviewers and speakers have also been asked to disclose any payments accepted for this lecture from any entity besides Sheppard Pratt, and if there will be discussion of any products, services, or off-label uses of product(s) during this presentation.
Elizabeth McIngvale, Ph.D., LCSW reports being the owner of OCD Institute of Texas, during the past 24 months. She will not discuss any products, services, or off-label uses in this presentation. All relationships have been mitigated through review.
Ryan Judd, LCSW-S, reports that he has no relationships with any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 24 months. He will not discuss any products, services, or off-label uses in this presentation. All relationships have been mitigated through review.
Event Planners/Reviewers Disclosures: The following event planners and/or reviewers are reported as having no financial interest, arrangement or affiliation with any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 24 months: Jon Hershfield, LCMFT, Todd Peters, MD, Michael C. Hann, MD, MBA, Ronald Means, MD, Rajeev Krishna, MD, PhD, MBA, Louis Marino, MD, Devi Bhuyan, PsyD, Manan Shah, MD, Vittoria DeLucia, MD, Chad J. Lennon, MD, Faith Dickerson, PhD, MPH, Carrie Etheridge, LCSW-C, Tom Flis, MS, BCBA, LBA, LCPC, Paula Bostwick, MSN, RN, CENP, Maggie O'Neill MSN, RN, PMH-BC, Rekeya Leslie, MSN, RN, CMSRN, PMH-BC, Nina Williamson, BSN, BA, PMH-BC, Lisa Illum, MLIS, MEd, and Jennifer Tornabene.
Physician Statement: Sheppard Pratt is accredited by The Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. Sheppard Pratt designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nurse Statement: Sheppard Pratt is approved as a provider of nursing continuing professional development by the Maryland Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. This activity provides 1.0 contact hour for nurses.
Psychologist Statement: Sheppard Pratt is authorized by the State Board of Examiners of Psychologists as a sponsor of continuing education. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CE activity. Sheppard Pratt designates this educational activity for a maximum of 1.0 contact hour for Psychologists.
Social Worker Statement: Sheppard Pratt is authorized by the Board of Social Work Examiners of Maryland to offer continuing education for Social Workers. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CE activity. This activity is approved for 1.0 contact hour in Category I credits for Social Workers.
Counselor Statement: Sheppard Pratt has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 5098. Programs that do not qualify for NBCC credit are clearly identified. Sheppard Pratt is solely responsible for all aspects of the program. This activity is available for 1.0 NBCC clock hours.
Available Credit
- 1.00 ACEP NBCC clock hours
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Category I credits for Social Workers
- 1.00 Psychologists
- 1.00 MNA Contact Hours for Nurses
- 1.00 Participation
Directions to attend and complete the activity for credit are located on the Overview tab.
Click the Take Course button to proceed into the course to complete the requirements for credit.
Required Hardware/software
Optimal System Configuration
Flash Player: Adobe Flash Player 10.1+
Browser: Firefox 3+, Internet Explorer 8.0+, Safari 4.0+, or Google Chrome 7.0+
Operating System: Windows XP+ or Mac OS X 10.4+
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Windows PC: 500-MHz Pentium II; Windows XP or higher; 128 MB RAM; Video Card at least 64MB of video memory; Sound Card at least 16-bit; Macromedia Flash Player 10 or higher, audio playback with speakers for programs with video content; Firefox 1.1+, Internet Explorer 7.0+, Safari 1.0+, Google Chrome, or Opera
Macintosh: Mac OS X 10.3 or higher with latest updates installed; 1.83MHz Intel Core Duo or faster; RAM: 128MB or more; Video Card: at least 64MB of video memory; Sound Card: at least 16-bit
Hardware/Software Specifications
This internet-based CME activity is best experienced using Internet Explorer 8+, Mozilla Firefox 3+, Safari 4+. This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat, Microsoft PowerPoint, and Windows Media Player.

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